The average age of the world's population is increasing at an unprecedented rate. The number of people worldwide age 65 and older is estimated at 506 million as of midyear 2008; by 2040, that number will hit 1.3 billion. Thus, in just over 30 years, the proportion of older people will double from 7 percent to 14 percent of the total world population, according to a new report, “An Aging World: 2008.”
Subjects in their own residences as well as those in independent living facilities (ILF), Assisted Living Facilities (ALF) and staffed nursing facilities (SNF) (here in after referred to as residences) can benefit from or may require regular or additional supervision from a caretaker to provide early detection of changes in behavior or normal patterns of daily activities that may indicate or coincide with changes in their health or activities that can lead to injuries from accident. This monitoring requirement is particularly acute for people that suffer from more advanced cognitive diseases such as dementia or Alzheimer's. For instance each year, an average nursing home with 100 beds reports 100 to 200 falls (Rubenstein L Z. Preventing falls in the nursing home. Journal of the American Medical Association 1997; 2780:595-6). A significant number of older adults living in residence homes die each year from fall-related injuries. Those who experience non-fatal falls can suffer injuries, have difficulty getting around and have a reduced quality of life (Rubenstein L Z, Josephson K R, Robbins A S Falls in the nursing home. Annals of Internal Medicine 1994; 121:442-51.) Specifically, 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures. According to figures of the US department of Health—Center for Disease Control and prevention, in 2003, 1.5 million people aged 65 years and older lived in nursing homes. If the current rates continue, by 2030 this number will rise to about 3 million. About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group. As many as 3 out of 4 nursing home residents fall each year which is twice the rate of older adults who are not in health care or retirement facilities. Moreover, the average falls per person per year is 2.6. About 35% of fall injuries occur among residents with reduced mobility. Falls result in disability, functional decline and reduced quality of life and the fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.
The challenge in caring for clients is the enormous burden of visually monitoring each client. The challenge primarily comes when an individual falls in a room or bathroom and there is no one watching them during this time. Due to overburdened staff in most facilities it is almost impossible to determine what an effective response is required until you have visually identified the situation. Technology can help to fill gaps left by a limited and budget constrained care-giving workforce and dispersed families.
Falling can be a sign of other health problems. People in nursing homes are generally frailer than other adults living in the community. They are generally older, have more chronic conditions, and have difficulty walking. They also tend to have problems with thinking or memory, to have difficulty with activities of daily living, and need help getting around or taking care of themselves. According to the Journal of the American Geriatrics Society all of these factors are linked to falling. Outlined in table 1 (see FIG. 1) are the potential cost impacts of a subject under care falling (table 1 from Ziegler Senior living and finance strategy conference 2009 Optimizing technology investments: best care for best cost presentation).
Caregivers of clients suffering from Alzheimer's disease and related dementia diseases face numerous additional challenges. In particular such clients need more frequent monitoring to ensure their well-being and that they do not harm themselves. With limited time and/or client to caregiver ratios increasing, it is difficult to monitor their activity constantly and consistently.
This visual identification is time and resource heavy for caregivers as well as larger scale nursing homes and hospital environments. Additionally family members may also want to monitor the general well-being of an ailing family member may be constrained by distance.
Client monitoring has been attempted with video yet this approach still requires significant human interaction and it is often resisted or refused as personal invasion of privacy. Many care facilities would not video monitor a patient without their explicit permission. Even if they do receive permission, it only nominally lowers the 1-1 ratio of patient care required for monitoring and analysis.
Various GPS monitoring systems, RF ID systems and personal emergency response devices based on accelerometer technology have been developed to track or monitor the whereabouts of clients. For example, certain products include personal response devices worn on a wristband or pendant and having a signaling button which allows the person in need to summon help at any time, without speech from trained personnel. Various other products provide alarm signaling devices that can be attached to the patient's body. However, some of these products have significant disadvantages; namely, they sometimes require the cognizance of the patient to ask for help which is not always possible with patients suffering from dementia and the like inflictions. Other disadvantages are the ability of the patient to communicate with a dispatch center. Still other products include sensors in various rooms for sensing the presence or absence of the subject in a given room. Yet, these systems often do not provide sufficient information required by caregivers.
There thus remains a need to monitor the activity risk without direct observation of a subject in order to better track, react faster to, and even predict health-impairing situations before or shortly after they occur.